Consequences of Substance Use, Misuse, and Abuse
Substance use is a highly significant cause of preventable death in the United States. Substance abuse and misuse are responsible for a large number of annual deaths. As illustrated in the table below, in 2000, tobacco use was responsible for 435,000 deaths, alcohol consumption for 85,000, and illicit drug use 17,000. This does not take into account the many non-fatal physical, personal, and social consequences of use, misuse, and abuse of substances.
Medical Consequences of Substance Use and Abuse
In addition to death, substance misuse and abuse can lead to a wide variety of negative personal consequences for our patients, including physiological effects and interpersonal ones.
Considering alcohol alone, the statistics are grim. Approximately 5,000 individuals under the age of 21 die annually from injuries related to alcohol use. Of these, about 1,900 individuals died from motor vehicle accidents, 1,600 from homicide, and 300 from suicide. In fact, in 2000, individuals from 12 to 17 years old who reported past-year alcohol use (19.6%) were more than twice as likely as youths who did not (8.6%) to be at risk for suicide during this time period. And of all children under age 14 killed in vehicle crashes in 2006, 23% were killed in alcohol-related crashes. U.S. high school students who frequently binge drink are at higher risk of physical and sexual assault, multiple types of non-fatal injuries including motor vehicle accidents and engaging in risky sexual behavior.
But these numbers only tell a small part of the story. Alcohol and other substance use have numerous short and long-term consequences for the mental, physical, and social well-being of the adolescent. For example, among adolescents who drink alcohol, 38-62% report having had problems related to their drinking, such as interference with work, emotional /psychological health problems, development of tolerance, and inability to reduce frequency and quantity of use.
Fetal consequences of maternal substance use
|
Substance |
Fetal consequence |
| Alcohol | Microcephaly; growth deficiency; CNS dysfunction, including mental retardation and behavioral abnormalities; craniofacial abnormalities (ie, short palpebral fissures, hypoplastic philtrum, flattened maxilla); behavioral abnormalities; abortiona, still birth |
| Cannabis | Reduction of 0.8 weeks in length of gestation, corresponding decrease in birth weight; subtle behavioral alterations, impaired executive functioninga, ventricular septal defecta |
| CNS sedatives (barbiturates, benzodiazepines, meprobamate, methaqualone) | Cleft palatea; depression of interactive behavior; neonatal withdrawal |
| CNS stimulants (amphetamines, cocaine, methylphenidate, phenmetrazine) | Abortiona; excess activity in utero; congenital anomalies (heart, biliary atresia); depression of interactive behavior; urinary tract defects; symmetric growth restriction; placental abruption; cerebral infarction; brain lesions; cranial defectsa; fetal death; neonatal necrotizing enterocolitis; shortened labor |
| Hallucinogens (LSD, ketamine, mescaline, PCP) | Chromosomal breakagea (LSD); dysmorphic face; Lysergic acid behavioral problems; possible increase in spontaneous abortions |
| Inhalants | Similar to the fetal alcohol and fetal hydantoin syndromesa; growth restriction; preterm labor; increased risk of leukemia in children; impaired heme synthesis |
| Narcotics | Absent birth defect syndrome; intrauterine withdrawal with increased fetal activity; depressed breathing movements; preterm delivery; preterm rupture of the membranes; fetal growth restriction; meconium stained amniotic fluid; perinatal mortality; neonatal abstinence syndrome; sudden infant deatha |
| Tobacco | Reduced birthweight (200 g lighter); preterm birth; placenta previa, placental abruption; reduced risk of pre-eclampsia; spontaneous abortiona |
a Conflicting reports in human literature
Adapted from Rayburn WF. Maternal and Fetal Effects from Substance Use. Clinics in Perinatology. 34(2007):559–571.
Effects of substance use on female reproductive system
Alcohol consumption during adolescence is known to affect growth, body composition and the menstrual cycle. Even moderate alcohol intake has been shown to depress estrogen levels for up to 2 weeks in adolescent girls aged 12 to 18.
Menstruating women with moderate to high alcohol intake are known to have a variety of menstrual and reproductive disorders, from irregular menstrual cycles to complete cessation of menses, absence of ovulation (i.e., anovulation), and infertility. Among women with infrequent, non-binge pattern alcohol, pituitary LH secretion can be affected resulting in temporary anovulatory states.
In the post-menopausal period, alcohol intake among individuals taking hormone replacement therapy (HRT) may cause abnormal fluctuations in estradiol levels that are not observed among women not using HRT who drink alcohol. Acute alcohol exposure in these women can cause a temporary increase in estradiol while chronic alcohol exposure may cause lower levels. This may have implications for use, risks
Source: Emanuele MA, Wezeman F., and Emanuele NV. Alcohol’s Effects on Female Reproductive Function. Alcohol Research & Health. 2002. 26(4):274-281.
Hazardous alcohol consumption, for example, can affect practically every aspect of a person’s health and well being, as illustrated in this poster courtesy of the Academic Edge, Inc.
Moreover, although specific detrimental effects of substance use vary by substance type, level of use, and individual patient factors, in general, it can affect all body systems. The table below captures a few of these effects.
Physiological Consequences of Substance Use
| Substance | Alternate Names | Forms | Selected Medical Consequences |
| Anabolic steroids | pumpers, stackers, weight trainers | oral, injectable | hepatic tumors, HTN, male hypogonadism, gynecomastia, infertility, hirsuitism, amenorrhea, premature skeletal maturation and accelerated puberty in adolescents, irritability, psychosis |
| Alcohol | Beer, wine, liquor, malt liquor | oral | gastritis, peptic ulcer disease, pancreatitis, chronic diarrhea, steatohepatitis, hepatitis, cholestasis, portal HTN, cirrhosis, arrhythmia, cardiomyopathy, HTN, CVA, malnutrition, cytopenias, menstrual irregularities, gestational/neonatal complications (fetal alcohol spectrum disorders, miscarriage, low birth weight, preterm birth, placental abruption, intracranial hemorrhage), withdrawal syndrome, cerebral degeneration, encephalopathy, polyneuropathy, myopathy, traumatic injuries |
| GHB | G, liquid ecstasy, soap | oral, injectable | somnolence, coma, death due to CNS depression, cognitive impairment, hallucination, seizure, headache, amnesia |
| Cocaine | base, blanca, blow, coke, crack, flake, rock | Powder can be snorted or liquefied and injected IV; hydrochloride form (crack) is smoked | sudden death, HTN, arrythmia, myocardial ischemia/infarction, headache, CVA (ischemic and hemorrhagic), cerebral vasculitis, pulmonary hypersensitivity (“crack lung”), pulmonary edema, pneumothorax, pneumonia, rhabdomyolysis, intestinal ischemia, gestational/neonatal complications (low birth weight, preterm birth, placental abruption, microcephaly), gingival ulceration/erosion of enamel, increased risk of contracting HIV/hepatitis C/other STDs |
| Heroin | dope, H, horse, smack | snorted, injected, smoked | vomiting, constipation, somnolence, death due to CNS depression, cognitive impairment, venous sclerosis, bacteremia, septic or inorganic (from additives often found in street heroin) emboli to various organs, increased risk of contracting HIV/hepatitis B&C/other STDs/pneumonia/TB, immune-mediated arthritis |
| Inhalants | whippets, poppers, snappers | inhaling chemical vapors | nausea, vomiting, somnolence, unconsciousness, death, disinhibition, dizziness, agitation, confusion, seizure, delirium, ataxia, headache, flushing, vasodilation, tachycardia, hepatic failure, renal failure |
| Ketamine | special K, vitamin K, jet | oral, injectable | dissociative anesthesia, hallucination, impaired memory, anxiety, delirium, HTN, rhabdomyolysis |
| Lysergic acid diethylamide (LSD) | acid, blotter, pane | oral, topical ocular use | hallucination, delusion, mood changes, pupillary dilatation, increased temp/BP/pulse |
| Marijuana | blunt, ganga, grass, joint, MJ, pot, weed | smoked | memory impairment, cognitive impairment, motor incoordination, tachycardia, anxiety, bronchogenic carcinoma |
| Methylene dioxymeth amphetamine (MDMA) |
ecstasy, love drug, X, XTC | oral | nausea, vomiting, anorexia, anxiety, depression, impulsivity, hyperthermia, HTN, rhabdomyolysis |
| Methamphetamine | cystal, glass, ice, meth, speed | oral, injectable, snorted, smoked | anorexia, psychosis, insomnia, anxiety, seizure, irritability/aggression, hallucination, myocardial infarction, CVA |
| Phencyclidine (PCP) | angel dust, ozone, rocket fuel, wack | oral, snorted, smoked | nausea, vomiting, blurred vision, agitation, violent behavior, psychosis, seizure, coma, death |
| Rohypnol | roofies, circles, forget me drug | oral, snorted | amnesia, disinhibition, somnolence, ataxia |
| Tobacco | smoked, “chewed” or “dipped” by placing in oral cavity for absorbtion by oral mucosa | COPD; cancer of the head, neck, lungs, esophagus, bladder, cervix, pancreas, kidneys; gestational/neonatal complications (low birth weight, miscarriage, SIDS, increased risk of child being addicted to nicotine in future if that child starts smoking) |
The important thing to remember is not which substances affect which systems, although understanding such a relationship can suggest when a particular patient’s symptomology may in fact be related to substance use, but rather than substance use has a pervasive effect on our patients’ health and that by screening each and every patient on a regular basis we can do our part in reducing these negative outcomes.
Many substances, particularly alcohol, are related to or exacerbate mood disorders. For example, girls ages 12 to 16 who are current drinkers are four times more likely than their nondrinking peers to suffer from depression.
Social Consequences of Substance Use and Abuse
Beyond physiological effects, the social costs of substance use and abuse can be very serious as well.
- Personal Relationships
- Increasing isolation from non-using individuals
- Strongest connection is with drug of choice
- Connections with friends and family become secondary or cease altogether
- Loss of social support can cause vicious cycle, furthering isolation
- Financial
- Cost of substance use affects personal and/or family
- Lack of professional growth
- Loss of income/job
- Costs of consequences of use, including arrest
- Family
- Loss of spouse/significant other
- Loss of dependent or adult children
- Loss of child custody
- Legal
- Direct consequences of drug use such as possession of illegal substances, driving under the influence of substance use, etc.
- Personal Relationships
- Increasing isolation from non-using individuals
- Strongest connection is with drug of choice
- Connections with friends and family become secondary or cease altogether
- Loss of social support can cause vicious cycle, furthering isolation
- Financial
- Cost of substance use affects personal and/or family
- Loss of income/job
- Costs of consequences of use, including arrest
- Academic
- Penalties issued from school including expulsion
- Poor performance in school that may lead to failure to progress/graduate
- Legal
- Direct consequences of drug use such as possession of illegal substances, driving under the influence of substance use, etc.
Adolescent Use, College Abuse and Consequences
For those of you who are involved in the care of older adolescents and young adults, let’s consider the spectrum of problems associated with risky drinking during the college years.
| Alcohol abuse and dependence | 31% college students met criteria for alcohol abuse and 6% for alcohol dependence in past 12 mos, by self-reports |
| Law enforcement involvement | ~ 5 % of 4-year college students are involved with police as a result of drinking |
| Drunk driving | 3,360,000 students (18-24yo) drive under the influence |
| Vandalism | ~11% college student drinkers damaged property under the influence |
| Health problems | >150,000 students develop alcohol-related health problems |
| Academic problems | ~ 25% college students report academic consequences of drinking |
| Risky sex behavior | : >100,000 students (18-24yo) report being too intoxicated to know if they consented to sex |
| Sexual assault | 97,000 students (18-24yo) are victims of alcohol-related sexual assault |
| Non-sexual assault | 696,000 students (18-24yo) are assaulted by intoxicated student |
| Injury | 599,000 students (18-24yo) are unintentionally injured under the influence |
| Suicide attempt | 1.2-1.5% tried to commit suicide within past year due to drinking or drug use |
| Death | 1,825 U.S. college students (18-24yo) die from alcohol-related unintentional injuries, including MVA’s |
Big Problems. What to do?
Substance misuse and abuse are prevalent and lead to significant personal and societal consequences. But small steps that all providers can easily take with each and every one of their patients can lead to earlier detection of problems, increased effectiveness of treatment, and reduction in long term prevalence and sequalae. The question is, how?